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Journal of Global Health Jul 2022Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Breech presentation delivery approach is a controversial issue in obstetrics. How to cope with breech delivery (vaginal or C-section) has been discussed to find the safest in terms of morbidity. The aim of this study was to assess the risks of foetal and maternal mortality and perinatal morbidity associated with vaginal delivery against elective caesarean in breech presentations, as reported in observational studies.
METHODS
Studies assessing perinatal morbidity and mortality associated with breech presentations births. Cochrane, Medline, Scopus, Embase, Web of Science, and Cuiden databases were consulted. This protocol was registered in PROSPERO CRD42020197598. Selection criteria were: years between 2010 and 2020, in English language, and full-term gestation (37-42 weeks). The methodological quality of the eligible articles was assessed according to the Newcastle-Ottawa scale. Meta-analyses were performed to study each parameter related to neonatal mortality and maternal morbidity.
RESULTS
The meta-analysis included 94 285 births with breech presentation. The relative risk of perinatal mortality was 5.48 (95% confidence interval (CI) = 2.61-11.51) times higher in the vaginal delivery group, 4.12 (95% CI = 2.46-6.89) for birth trauma and 3.33 (95% CI = 1.95-5.67) for Apgar results. Maternal morbidity showed a relative risk 0.30 (95% CI = 0.13-0.67) times higher in the planned caesarean group.
CONCLUSIONS
An increment in the risk of perinatal mortality, birth trauma, and Apgar lower than 7 was identified in planned vaginal delivery. However, the risk of severe maternal morbidity because of complications of a planned caesarean was slightly higher.
Topics: Breech Presentation; Cesarean Section; Delivery, Obstetric; Elective Surgical Procedures; Female; Humans; Infant, Newborn; Observational Studies as Topic; Perinatal Death; Perinatal Mortality; Pregnancy
PubMed: 35976004
DOI: 10.7189/jogh.12.04055 -
The Journal of Maternal-fetal &... Nov 2020Given the increasing rate of cesarean delivery and request without maternal or fetal indication among pregnant women, this systematic review was conducted to obtain the...
Given the increasing rate of cesarean delivery and request without maternal or fetal indication among pregnant women, this systematic review was conducted to obtain the reasons for maternal request for elective cesarean section. We searched published studies from the first year of records through August 2018 in PubMed, Scopus, and Web of Science. The quality assessment of the studies was performed by the improved Newcastle-Ottawa Scale. Due to data heterogeneity; no meta-analysis was performed. Twenty-eight studies met the inclusion criteria and were included in the review. The results of studies on the reasons of maternal request for elective cesarean section were fear of labor pain, anxiety for fetal injury/death, fear of childbirth, urinary incontinence, pelvic floor and vaginal trauma, doctors suggestion, time of birth, experience of prior bad delivery, previous infertility, infertility, anxiety for gynecologic examination, anxiety for loss of control, avoid long labor, anxiety for lack of support from the staff, fear of fecal, emotional aspects, body weight of the infant at birth and abnormal prenatal examination. The results of studies on the demographic reasons of maternal request for elective cesarean section were advanced maternal age, parity, occupation, education, maternal obesity, family status, decreasing level of religiosity, household income, number of living children and age at marriage. Our study proposed that the comprehensive programs and the interventions of health promotion should be designed to reduce unnecessary cesarean section and improve the performance of vaginal delivery.
Topics: Cesarean Section; Child; Delivery, Obstetric; Elective Surgical Procedures; Female; Humans; Infant, Newborn; Parity; Parturition; Pregnancy; Pregnant Women
PubMed: 30810436
DOI: 10.1080/14767058.2019.1587407 -
The Cochrane Database of Systematic... Feb 2017Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001.
OBJECTIVES
To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 November 2016) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials involving a comparison of continuous cardiotocography (with and without fetal blood sampling) with no fetal monitoring, intermittent auscultation intermittent cardiotocography.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed study eligibility, quality and extracted data from included studies. Data were checked for accuracy.
MAIN RESULTS
We included 13 trials involving over 37,000 women. No new studies were included in this update.One trial (4044 women) compared continuous CTG with intermittent CTG, all other trials compared continuous CTG with intermittent auscultation. No data were found comparing no fetal monitoring with continuous CTG. Overall, methodological quality was mixed. All included studies were at high risk of performance bias, unclear or high risk of detection bias, and unclear risk of reporting bias. Only two trials were assessed at high methodological quality.Compared with intermittent auscultation, continuous cardiotocography showed no significant improvement in overall perinatal death rate (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.59 to 1.23, N = 33,513, 11 trials, low quality evidence), but was associated with halving neonatal seizure rates (RR 0.50, 95% CI 0.31 to 0.80, N = 32,386, 9 trials, moderate quality evidence). There was no difference in cerebral palsy rates (RR 1.75, 95% CI 0.84 to 3.63, N = 13,252, 2 trials, low quality evidence). There was an increase in caesarean sections associated with continuous CTG (RR 1.63, 95% CI 1.29 to 2.07, N = 18,861, 11 trials, low quality evidence). Women were also more likely to have instrumental vaginal births (RR 1.15, 95% CI 1.01 to 1.33, N = 18,615, 10 trials, low quality evidence). There was no difference in the incidence of cord blood acidosis (RR 0.92, 95% CI 0.27 to 3.11, N = 2494, 2 trials, very low quality evidence) or use of any pharmacological analgesia (RR 0.98, 95% CI 0.88 to 1.09, N = 1677, 3 trials, low quality evidence).Compared with intermittent CTG, continuous CTG made no difference to caesarean section rates (RR 1.29, 95% CI 0.84 to 1.97, N = 4044, 1 trial) or instrumental births (RR 1.16, 95% CI 0.92 to 1.46, N = 4044, 1 trial). Less cord blood acidosis was observed in women who had intermittent CTG, however, this result could have been due to chance (RR 1.43, 95% CI 0.95 to 2.14, N = 4044, 1 trial).Data for low risk, high risk, preterm pregnancy and high-quality trials subgroups were consistent with overall results. Access to fetal blood sampling did not appear to influence differences in neonatal seizures or other outcomes.Evidence was assessed using GRADE. Most outcomes were graded as low quality evidence (rates of perinatal death, cerebral palsy, caesarean section, instrumental vaginal births, and any pharmacological analgesia), and downgraded for limitations in design, inconsistency and imprecision of results. The remaining outcomes were downgraded to moderate quality (neonatal seizures) and very low quality (cord blood acidosis) due to similar concerns over limitations in design, inconsistency and imprecision.
AUTHORS' CONCLUSIONS
CTG during labour is associated with reduced rates of neonatal seizures, but no clear differences in cerebral palsy, infant mortality or other standard measures of neonatal wellbeing. However, continuous CTG was associated with an increase in caesarean sections and instrumental vaginal births. The challenge is how best to convey these results to women to enable them to make an informed decision without compromising the normality of labour.The question remains as to whether future randomised trials should measure efficacy (the intrinsic value of continuous CTG in trying to prevent adverse neonatal outcomes under optimal clinical conditions) or effectiveness (the effect of this technique in routine clinical practice).Along with the need for further investigations into long-term effects of operative births for women and babies, much remains to be learned about the causation and possible links between antenatal or intrapartum events, neonatal seizures and long-term neurodevelopmental outcomes, whilst considering changes in clinical practice over the intervening years (one-to-one-support during labour, caesarean section rates). The large number of babies randomised to the trials in this review have now reached adulthood and could potentially provide a unique opportunity to clarify if a reduction in neonatal seizures is something inconsequential that should not greatly influence women's and clinicians' choices, or if seizure reduction leads to long-term benefits for babies. Defining meaningful neurological and behavioural outcomes that could be measured in large cohorts of young adults poses huge challenges. However, it is important to collect data from these women and babies while medical records still exist, where possible describe women's mobility and positions during labour and birth, and clarify if these might impact on outcomes. Research should also address the possible contribution of the supine position to adverse outcomes for babies, and assess whether the use of mobility and positions can further reduce the low incidence of neonatal seizures and improve psychological outcomes for women.
Topics: Cardiotocography; Cesarean Section; Female; Heart Auscultation; Heart Rate, Fetal; Humans; Infant; Infant Mortality; Infant, Newborn; Labor, Obstetric; Pregnancy; Randomized Controlled Trials as Topic; Seizures
PubMed: 28157275
DOI: 10.1002/14651858.CD006066.pub3 -
The Cochrane Database of Systematic... Feb 2019Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. With... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously. Active management was introduced to try to reduce haemorrhage, a major contributor to maternal mortality in low-income countries. This is an update of a review last published in 2015.
OBJECTIVES
To compare the effects of active versus expectant management of the third stage of labour on severe primary postpartum haemorrhage (PPH) and other maternal and infant outcomes.To compare the effects of variations in the packages of active and expectant management of the third stage of labour on severe primary PPH and other maternal and infant outcomes.
SEARCH METHODS
For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the World health Organization International Clinical Trials Registry Platform (ICTRP), on 22 January 2018, and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials comparing active versus expectant management of the third stage of labour. Cluster-randomised trials were eligible for inclusion, but none were identified.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the studies for inclusion, assessed risk of bias, carried out data extraction and assessed the quality of the evidence using the GRADE approach.
MAIN RESULTS
We included eight studies, involving analysis of data from 8892 women. The studies were all undertaken in hospitals, seven in higher-income countries and one in a lower-income country. Four studies compared active versus expectant management, and four compared active versus a mixture of managements. We used a random-effects model in the analyses because of clinical heterogeneity. Of the eight studies included, we considered three studies as having low risk of bias in the main aspects of sequence generation, allocation concealment and completeness of data collection. There was an absence of high-quality evidence according to GRADE assessments for our primary outcomes, which is reflected in the cautious language below.The evidence suggested that, for women at mixed levels of risk of bleeding, it is uncertain whether active management reduces the average risk of maternal severe primary PPH (more than 1000 mL) at time of birth (average risk ratio (RR) 0.34, 95% confidence interval (CI) 0.14 to 0.87, 3 studies, 4636 women, I = 60%; GRADE: very low quality). For incidence of maternal haemoglobin (Hb) less than 9 g/dL following birth, active management of the third stage may reduce the number of women with anaemia after birth (average RR 0.50, 95% CI 0.30 to 0.83, 2 studies, 1572 women; GRADE: low quality). We also found that active management of the third stage may make little or no difference to the number of babies admitted to neonatal units (average RR 0.81, 95% CI 0.60 to 1.11, 2 studies, 3207 infants; GRADE: low quality). It is uncertain whether active management of the third stage reduces the number of babies with jaundice requiring treatment (RR 0.96, 95% CI 0.55 to 1.68, 2 studies, 3142 infants, I = 66%; GRADE: very low quality). There were no data on our other primary outcomes of very severe PPH at the time of birth (more than 2500 mL), maternal mortality, or neonatal polycythaemia needing treatment.Active management reduces mean maternal blood loss at birth and probably reduces the rate of primary blood loss greater than 500 mL, and the use of therapeutic uterotonics. Active management also probably reduces the mean birthweight of the baby, reflecting the lower blood volume from interference with placental transfusion. In addition, it may reduce the need for maternal blood transfusion. However, active management may increase maternal diastolic blood pressure, vomiting after birth, afterpains, use of analgesia from birth up to discharge from the labour ward, and more women returning to hospital with bleeding (outcome not pre-specified).In the comparison of women at low risk of excessive bleeding, there were similar findings, except it was uncertain whether there was a difference identified between groups for severe primary PPH (average RR 0.31, 95% CI 0.05 to 2.17; 2 studies, 2941 women, I = 71%), maternal Hb less than 9 g/dL at 24 to 72 hours (average RR 0.17, 95% CI 0.02 to 1.47; 1 study, 193 women) or the need for neonatal admission (average RR 1.02, 95% CI 0.55 to 1.88; 1 study, 1512 women). In this group, active management may make little difference to the rate of neonatal jaundice requiring phototherapy (average RR 1.31, 95% CI 0.78 to 2.18; 1 study, 1447 women).Hypertension and interference with placental transfusion might be avoided by using modifications to the active management package, for example, omitting ergot and deferring cord clamping, but we have no direct evidence of this here.
AUTHORS' CONCLUSIONS
Although the data appeared to show that active management reduced the risk of severe primary PPH greater than 1000 mL at the time of birth, we are uncertain of this finding because of the very low-quality evidence. Active management may reduce the incidence of maternal anaemia (Hb less than 9 g/dL) following birth, but harms such as postnatal hypertension, pain and return to hospital due to bleeding were identified.In women at low risk of excessive bleeding, it is uncertain whether there was a difference between active and expectant management for severe PPH or maternal Hb less than 9 g/dL (at 24 to 72 hours). Women could be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third-stage management. Data are also required from low-income countries.It must be emphasised that this review includes only a small number of studies with relatively small numbers of participants, and the quality of evidence for primary outcomes is low or very low.
Topics: Birth Weight; Constriction; Delivery, Obstetric; Female; Humans; Infant, Newborn; Jaundice, Neonatal; Labor Stage, Third; Oxytocics; Placenta; Postpartum Hemorrhage; Pregnancy; Randomized Controlled Trials as Topic; Watchful Waiting
PubMed: 30754073
DOI: 10.1002/14651858.CD007412.pub5 -
International Journal of Health Sciences 2022Although teenage pregnancy has declined in the last decade, it remains a major public health issue in Africa. Maternal mortality is common among teenagers due to their... (Review)
Review
OBJECTIVE
Although teenage pregnancy has declined in the last decade, it remains a major public health issue in Africa. Maternal mortality is common among teenagers due to their increased risk of obstetric and medical complications. In Africa, there is a lack of robust and comprehensive data on the prevalence and predictors of teenage pregnancy. As a result, this systematic review and meta-analysis were carried out to summarize evidence that will assist concerned entities in identifying existing gaps and proposing strategies to reduce teenage pregnancy in Africa.
METHODS
The review is registered by the international prospective register of systematic reviews (CRD42021275013). This search included all published and unpublished observational studies written in English between August 23, 2016, and August 23, 2021. The articles were searched using databases (PubMed, CINHAL [EBSCO], EMBASE, POPLINE, Google Scholar, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, and SCOPUS). Data synthesis and statistical analysis were conducted using STATA version 14 software. Forest plots were used to present the pooled prevalence and odds ratio (OR) with a 95% confidence interval (CI) of meta-analysis using the random effect model.
RESULTS
A total of 43,758 teenagers (aged 13-19) were included in 23 studies. In Africa, the overall pooled prevalence of teenage pregnancy was 30% (95% CI: 17-43). Western Africa had the highest prevalence of teenage pregnancy 33% (95% CI: 10-55). Age (18-19) (OR = 2.99 [95% CI = 1.124-7.927]), wealth index (OR = 1.84 [95% CI = 1.384-2.433]), and marital status (OR = 6.02 [95% CI = 2.348-15.43]) were predictors of teenage pregnancy in Africa.
CONCLUSION
In Africa, nearly one-third of teenagers become pregnant. Teenage pregnancy was predicted by age (18-19), wealth index, and marital status. Strengthening interventions aimed at increasing teenagers' economic independence, reducing child marriage, and increasing contraceptive use among married teenagers can help to prevent teenage pregnancy.
PubMed: 36475034
DOI: No ID Found -
The Journal of Obstetrics and... Jul 2023To estimate the incidence and identify risk factors of postpartum hemorrhage (PPH) after vaginal delivery. (Meta-Analysis)
Meta-Analysis Review
AIM
To estimate the incidence and identify risk factors of postpartum hemorrhage (PPH) after vaginal delivery.
METHODS
A systematic review and meta-analysis was conducted. PubMed, Cochrane Library, CINAHL, Web of Science, EMBASE, and ClinicalTrials.gov databases were systematically searched from inception to April 30th, 2022. Cross-sectional, cohort, case-control, and secondary analysis of randomized controlled studies that reported the incidence of PPH and the related risk factors in vaginal delivery were eligible through screening of 2343 articles. The incidence, associated standard error, adjusted odds ratios, relative risks and associated 95% confidence intervals were combined in the meta-analysis.
RESULTS
Thirty-six articles were included in the descriptive review. The incidence of PPH (blood loss ≥500 mL and blood loss ≥1000 mL) was 17% and 6%, respectively. Forty-one identified risk factors were divided into five categories under two criteria: history and demographics; maternal comorbidity; pregnancy-related factors; labor-related factors; delivery-related factors.
CONCLUSIONS
With the increasing incidence of PPH globally, obstetric health care providers need to improve their awareness of these multi-factorial risks to optimize obstetric care and reduce maternal morbidity. This systematic review and meta-analysis have raised important questions about the nature of vaginal delivery, such as the duration of prolonged labor, details on the use of oxytocin, and the presence of genital tract trauma. There should be highlighted by obstetric personnel on these factors during a patients' labor process.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Oxytocics; Incidence; Cross-Sectional Studies; Delivery, Obstetric; Oxytocin; Risk Factors
PubMed: 37069822
DOI: 10.1111/jog.15654 -
Frontiers in Global Women's Health 2022Obstetric emergencies are life-threatening medical problems that develop during pregnancy, labor, or delivery. There are a number of pregnancy-related illnesses and...
BACKGROUND
Obstetric emergencies are life-threatening medical problems that develop during pregnancy, labor, or delivery. There are a number of pregnancy-related illnesses and disorders that can endanger both the mother's and the child's health. During active labor and after delivery, obstetrical crises can arise (postpartum). While the vast majority of pregnancies and births proceed without a hitch, all pregnancies are not without risk. Pregnancy can bring joy and excitement, but it can also bring anxiety and concern. Preterm birth, stillbirth, and low birth weight are all adverse pregnancy outcomes, leading causes of infant illness, mortality, and long-term physical and psychological disorders.
PURPOSE
The purpose of this study is to assess the magnitude and association of obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia.
METHOD
We used four databases to locate the article: PUBMED, HINARI, SCIENCE DIRECT, and Google Scholar. Afterward, a search of the reference lists of the identified studies was done to retrieve additional articles. For this review, the PEO (population, exposure, and outcomes) search strategy was used. Population: women who had obstetric emergencies in Ethiopia. Exposure: predictors of obstetric emergencies. Outcome: Women who had an adverse perinatal outcome. Ethiopian women were the object of interest. The primary outcome was the prevalence of adverse maternal and perinatal outcomes among Ethiopian women. Obstetrical emergencies are life-threatening obstetrical conditions that occur during pregnancy or during or after labor and delivery. The Joanna Briggs Institute quality assessment tool was used to critically appraise the methodological quality of studies. Two authors abstracted the data by study year, study design, sample size, data collection method, and study outcome. Individual studies were synthesized using comprehensive meta-analysis software and STATA version 16. Statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the statistics. Summary statistics (pooled effect sizes) in an odd ratio with 95% confidence intervals were calculated.
RESULT
A total of 35 studies were used for determining the pooled prevalence of adverse maternal and perinatal outcomes; twenty-seven were included in determining the odd with 95% CI in the meta-analysis, from which 14 were cross-sectional, nine were unmatched case-control studies, and 14 were conducted in the south nation and nationality Peoples' Region, and eight were from Amhara regional states, including 40,139 women who had an obstetric emergency. The magnitude of adverse maternal and perinatal outcomes following obstetric emergencies in Ethiopia was 15.9 and 37.1%, respectively. The adverse maternal outcome increased by 95% in women having obstetric emergencies (OR 2.29,95% CI 2.43-3.52), and perinatal deaths also increased by 95% in women having obstetric emergencies (OR 3.84,95% CI 3.03-4.65) as compared with normotensive women.
CONCLUSION
This review demonstrated the high prevalence of perinatal mortality among pregnant women with one of the obstetric emergencies in Ethiopia. Adverse maternal and perinatal outcomes following obstetric emergencies such as ICU admission, development of PPH, giving birth CS, maternal death, NICU admission, LBW, and perinatal death were commonly reported in this study.
PubMed: 36386434
DOI: 10.3389/fgwh.2022.942668 -
Journal of Human Lactation : Official... Aug 2016Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding.... (Review)
Review
Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Breast Feeding; Female; Humans; Postpartum Period; Pregnancy
PubMed: 27121239
DOI: 10.1177/0890334415623779 -
Journal of Midwifery & Women's Health 2015The aim of this study was to systematically review current evidence for the relationship between obstetric anal sphincter injury (ie, episiotomy and third- or... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The aim of this study was to systematically review current evidence for the relationship between obstetric anal sphincter injury (ie, episiotomy and third- or fourth-degree perineal lacerations) and anal incontinence in parous women.
METHODS
PubMed, Ovid (MEDLINE), Cochrane Trials, and Cumulative Index to Nursing and Allied Health Literature were searched. Studies eligible for review assessed the relationship between episiotomy and/or third- or fourth-degree perineal laceration and anal incontinence. Two reviewers independently searched for studies for review and used the Meta-Analysis of Observational Studies in Epidemiology guidelines. Quality of individual studies was appraised using the Downs and Black criteria. Pooled effect sizes were estimated for the relationships between episiotomy and third- or fourth-degree perineal laceration with anal incontinence using random effects meta-analysis models. Heterogeneity of each model was assessed using Cochran Q and I(2) statistics.
RESULTS
Of 578 articles, 19 studies (7 prospective cohort studies, 6 retrospective studies, one case-control study, and 5 population-based cross-sectional studies) met inclusion/exclusion criteria for the systematic review. Of the 19 studies, 3 examined episiotomy, 7 examined third- or fourth-degree perineal laceration, and 9 studies examined both risk factors for anal incontinence. Eight studies (N = 2929 women) examining the relationship between episiotomy and anal incontinence and 12 studies (N = 2288 women) examining the relationship between third- or fourth-degree perineal laceration and anal incontinence met criteria for inclusion in the meta-analyses. Pooled odds ratios (ORs) demonstrated a significant association between perineal trauma (episiotomy [OR, 1.74; 95% confidence interval [CI], 1.28-2.38; Q = 8.9; P < .26; I(2) = 21.4] and third- or fourth-degree perineal laceration (OR, 2.66; 95% CI, 1.77-3.98; Q = 27.9; P = .002; I2 = 64.1) and anal incontinence.
DISCUSSION
Both episiotomy and third- or fourth-degree perineal laceration are significantly associated with anal incontinence after vaginal birth. The evidence provided in this systematic review and meta-analysis highlights the importance of reducing perineal trauma during vaginal births in order to ameliorate anal incontinence in parous women.
Topics: Anal Canal; Episiotomy; Fecal Incontinence; Female; Humans; Lacerations; Obstetric Labor Complications; Perineum; Pregnancy
PubMed: 25712278
DOI: 10.1111/jmwh.12283 -
International Journal of Nursing Studies Sep 2023Perineal lacerations could lead to substantial morbidities for women. A reliable prediction model for perineal lacerations has the potential to guide the prevention....
BACKGROUND
Perineal lacerations could lead to substantial morbidities for women. A reliable prediction model for perineal lacerations has the potential to guide the prevention. Although several prediction models have been developed to estimate the risk of perineal lacerations, especially third- and fourth-degree perineal lacerations, the evidence about the model quality and clinical applicability is scarce.
OBJECTIVES
To systematically review and critically appraise the existing prediction models for perineal lacerations.
METHODS
Seven databases (PubMed, Embase, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, SinoMed, China National Knowledge Infrastructure, and Wanfang Data) were systematically searched from inception to July 2022. Studies that developed prediction models for perineal lacerations or performed external validation of existing models were considered eligible to include in the systematic review. Two reviewers independently conducted data extraction according to the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies. The risk of bias and the applicability of the included models were assessed with the Prediction Model Risk of Bias Assessment Tool. A narrative synthesis was performed to summarize the characteristics, risk of bias, and performance of existing models.
RESULTS
Of 4345 retrieved studies, 14 studies with 22 prediction models for perineal lacerations were included. The included models mainly aimed to estimate the risk of third- and fourth-degree perineal lacerations. The top five predictors used were operative vaginal birth (72.7 %), parity/previous vaginal birth (63.6 %), race/ethnicity (59.1 %), maternal age (50.0 %), and episiotomy (40.1 %). Internal and external validation was performed in 12 (54.5 %) and seven (31.8 %) models, respectively. 13 studies (92.9 %) assessed model discrimination, with the c-index ranging from 0.636 to 0.830. Seven studies (50.0 %) evaluated the model calibration using the Hosmer-Lemeshow test, Brier score, or calibration curve. The results indicated that most of the models had fairly good calibration. All the included models were at higher risk of bias mainly due to unclear or inappropriate methods for handling missing data and continuous predictors, external validation, and model performance evaluation. Six models (27.3 %) showed low concerns about applicability.
CONCLUSIONS
The existing models for perineal lacerations were poorly validated and evaluated, among which only two have the potential for clinical use: one for women undergoing vaginal birth after cesarean delivery, and the other one for all women undergoing vaginal birth. Future studies should focus on robust external validation of existing models and the development of novel models for second-degree perineal laceration.
PROSPERO REGISTRATION NUMBER
CRD42022349786.
TWEETABLE ABSTRACT
The existing models for perineal lacerations during childbirth need external validation and updating. Tools are needed for second-degree perineal laceration.
Topics: Female; Humans; Pregnancy; Delivery, Obstetric; Episiotomy; Lacerations; Parity; Perineum; Risk Factors
PubMed: 37423201
DOI: 10.1016/j.ijnurstu.2023.104546